Appeals Examiner - West Sacramento, CA (On-site)

About the role

As Appeals Examiner - West Sacramento, CA (On-site), you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

Responsibilities

• Review provider appeals using approved guidelines and document appeal determinations clearly and concisely.
• Analyze, research and review appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately while maintaining production goals and quality standards.
• Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation.
• Maintain performance within defined quality and quantitative objectives.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

Requirements

• 2 years or more in medical claims and appeals experience required.
• Experience working with medical insurance and/or medical terminology required.
• Highly proficient with exceptional level of accuracy required.
• Ability to research and verify claim payment issues.

Skills

• Knowledge of Microsoft products (Outlook, Word, Excel and TEAMS).

Schedule

On-site/Office environment at West Sacramento, CA. Hours are 6:00 a.m. – 2:30 p.m.

Pay

The pay range for this position is $37,500.00 - $53,500.00 per year; base pay may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience.

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies